HIV: A Comprehensive Guide to Science, Treatment, and Prevention

HIV Overview

HIV, also known as acquired immune syndrome (AIDS), is a systemic disease caused by the human immunodeficiency virus (HIV). The most common types include HIV-1 and HIV-2. HIV damages the immune system, reducing the body's ability to fight infection and disease. Without treatment, HIV can remain dormant for years, weakening the immune system and eventually leading to AIDS. In the United States, most people who are infected do not develop AIDS when they receive treatment. There is no cure for HIV/AIDS. However, medicines can be used to control the infection and prevent the disease from getting worse. Antiviral HIV treatments have reduced AIDS-related deaths worldwide. We are working to make more HIV/AIDS prevention and treatment methods available to resource-poor countries.

Causes

The only cause of AIDS is the entry of the human immunodeficiency virus (HIV) into the human body and the related infection. HIV mainly affects the human immune system, eventually leading to defects in the human cellular immune function, which in turn causes various opportunistic infections and tumors.

The cause of AIDS is that after HIV enters the human body, it destroys CD4+T lymphocytes (human immune cells), leading to defects in the human cellular immune function and weakening the defense against infection and cancer.

Infection Process

• After HIV enters the human body, it reaches the local lymph nodes within 24 to 48 hours.
• After about five days, the virus components can be detected in the blood. Viremia then occurs, leading to acute infection.
• In the acute phase of infection, the number of CD4+T lymphocytes decreases rapidly and temporarily.
• In most infected people, CD4+T lymphocytes can return to normal or near-normal levels without special treatment.
• However, because the human immune system cannot completely eliminate the virus, the infection develops into a chronic state. Untreated patients go through two stages: asymptomatic infection and symptomatic infection.
• Clinically, the infection can manifest in three forms: typical course, rapid course, and long-term slow course.

Asymptomatic Infection

The duration varies greatly (from a few months to decades), with an average of about 6 to 8 years. There are no obvious symptoms during the infection, and only blood tests show a slow decrease in CD4+ T lymphocyte counts.

Symptomatic Infection

When the CD4+ T lymphocyte count drops rapidly again, various symptoms will appear. Most infected people have a CD4+ T lymphocyte count of less than 350/µL. In some advanced patients, the count even drops below 200/µL and decreases rapidly.

HIV Transmission Routes

HIV infection can enter the human body through infected blood, semen or vaginal secretions. Infection can occur in the following situations:

• Sexual Transmission: If a person has sex with an HIV-infected person and does not use a condom, HIV infection may occur.
• Blood Transmission: Sharing syringes with HIV-infected people, transfusion of infected blood, and even used scalpels, blood transfusion equipment, etc., if not properly sterilized, can lead to HIV transmission.
• Mother-to-Child Transmission: If the mother is infected with HIV, the virus may be transmitted to the child during pregnancy, delivery and breastfeeding. However, HIV-infected mothers may also give birth to healthy babies.

Symptoms

The average incubation period of AIDS is 6 to 8 years, which can last from months to decades. From the initial infection of HIV to the final development stage, it is a relatively long and complicated process. Different stages of this process will have different manifestations.

Typical Symptoms

According to the various symptoms and signs that appear after the patient is infected, the entire process of HIV infection can be divided into the acute phase, the asymptomatic phase and the AIDS phase.

Early Symptoms

The more typical symptoms of early AIDS can be understood as the symptoms of the acute phase. The acute phase usually occurs 2 to 4 weeks after the initial infection of HIV. Some patients have symptoms caused by HIV viremia and acute damage to the immune system. Most patients exhibit mild clinical symptoms that resolve within 1-3 weeks. The most common symptom at this time is fever, which may be accompanied by sore throat, night sweats, nausea, vomiting, diarrhea, rash, joint pain, lymphadenopathy and neurological symptoms. Rapidly progressing patients may have severe infection or central nervous system symptoms and signs and related diseases during this period.

Symptoms of the Asymptomatic Period

Patients may enter the asymptomatic period from the acute phase, or directly enter the asymptomatic period without obvious acute phase symptoms. Generally, 6~8 years. During the asymptomatic period, HIV continues to replicate in the infected person's body, causing damage to the immune system. Symptoms or signs such as lymphadenopathy may appear during this period, but they are generally not easy to attract attention.

Symptoms of the AIDS Period

The AIDS period is the final stage after HIV infection. The patient's CD4+T lymphocyte count is often <200/μl, and the HIV viral load in the plasma is significantly increased. The main manifestations are HIV-related symptoms, signs, and various opportunistic infections and tumors.

Symptoms and Signs Related to HIV Infection

• Fever (>38℃) lasting for more than 1 month
• Night sweats
• Diarrhea (more than 3 bowel movements/day)
• Weight loss of more than 10% within 6 months
• Neuropsychiatric symptoms: memory loss, mental apathy, personality changes, headaches, epilepsy and dementia
• Systemic lymphadenopathy persistence: lymphadenopathy in 2 or more groins except; lymph node diameter ≥1cm, not tender, without adhesion; maintained for over 3 months

Associated Symptoms

The opportunistic infection and tumor of AIDS patients often involves the respiratory system, central nervous system, digestive tract, skin, eyes, etc., so many other symptoms will appear. The most common are as follows:

Bacterial Infections

• Bacterial pneumonia caused by Streptococcus, Streptococcus pneumoniae and Haemophilus influenzae
• Tuberculosis: It's the most common infective disease of AIDS patient and also it causes the most deaths in AIDS patients. When tuberculosis developed in AIDS patient, there will be system widely multi-organ infected manifestation such as fever, fatigue, drenching sweat, hunger, abdominal sore, diarrhea, and chronic cough.
• Opportunistic infection common with AIDS patient is pneumocystis carinii pneumonia, called Pneumocystis carinii pneumonia or Pneumocystis carinii. The infection developed slowly, manifested on temperature rise, chronic dry cough, and easily tired breath.

Protozoan Infections

• Infected with Toxoplasma gondii: more common in patients with low CD4 + T cell levels. The most common is toxoplasmic encephalopathy, with local encephalitis, fever, headache, coma, poor movement of the limbs, conjunctival chorioretinitis, etc.
• Cryptosporidium parvum infection: patients have persistent and severe diarrhea, malabsorption and weight loss.

Viral Infections

• Cytomegalovirus (CMV) infection: infection can affect multiple organs and may be accompanied by retinitis, which can lead to death in severe cases.
• Herpes simplex virus (HSV) infection: mainly causes herpes in mucous membranes and skin, and is prone to painful ulcers. In severe cases, herpes pneumonia and encephalitis may occur.
• Herpes zoster virus infection: lesions often occur in the intercostal nerves and trigeminal nerves, appearing as blisters or accompanied by severe pain, ulceration or hemorrhagic necrosis.
• Human papillomavirus (HPV) infection: can cause warts or genital warts.

Tumors

AIDS patients are prone to Kaposi's sarcoma, lymphoma, invasive cervical tumors, etc.

Kaposi's Sarcoma

Related symptoms may appear as the first symptoms of AIDS. Its typical manifestations are lesions on the skin of the lower limbs (toes and legs) and oral mucosa. As the disease progresses, multiple symmetrical oval lesions will appear on the trunk. Gastrointestinal tracts and lungs presented dark brown or purple-red infiltrations or nodules, which tended to ulcerate into lesions with rough surfaces and diffuse around the lymph nodes.

Lymphoma

AIDS patients can also develop lymphomas throughout the body, such as primary central nervous system lymphoma, metastatic lymphoma and skin lymphoma.

Medical Treatment

If you think you may have had unsafe sex or used a needle syringe belonging to others and may have been infected with HIV, please come to the hospital for examination as soon as possible.

Diagnosis

HIV can be diagnosed by blood or saliva tests. Tests include:

antigen/antibody test. This test uses blood from your arm. These antigens are substances of the HIV virus itself. After getting exposed to the HIV virus, this antigen in the blood could usually detect within few weeks. Your body's immune system would react by creating antibodies against the infected human immunodeficiency virus (HIV) as a response mechanism after having the infection and takes weeks till it actually produces antibodies inside your body. Therefore if you got yourself tested for combined HIV with 2 weeks after acquiring HIV, possibly then the result will become positive since antibody will still take months before their level is detected.

Anti-body Tests: Anti-Bodies refers to any specific antibodies made by individuals' Immune System that was acquired while being infected. Majority of Rapid HIV tests come under anti-bodies such as home self-tests which has the results that were displayed almost right about now or maybe a minute but at least it shouldn't go above two minutes when given time to develop, some lab tests even gives false negative reports, sometimes may indicate positivity and vice versa than it does through initial testing method where you don't require a lot more time because of all these types of things they tend give inaccurate testing results that should really not occur, which makes it extremely risky for using for diagnostic tools.

Nucleic acid test (NAT). This test looks for the virus in the blood (viral load). This also uses blood drawn from a vein.

NAT: If you could have been exposed to HIV in the last few weeks, your doc might order a NAT (nucleic acid test). This is the earliest test that becomes positive following an HIV exposure.

Treatment

There is no cure for HIV/AIDS; the body does not eliminate the virus upon infection. However, various drugs are available that can treat AIDS and prevent certain complications.

All people diagnosed with HIV should take antiretroviral therapy (ART) medicines. This approach should be used regardless of the stage of the disease and complications.

ART most often combines two or more drugs from different groups. It has the greatest likelihood of reducing the amount of HIV in the blood. In fact, some ART regimens combine two or more HIV medicines into a single once-a-day tablet.

Each type of drug blocks the virus in a different way. Treatment regimens combine different types of drugs to do the following:

• Address drug resistance (viral genotype).
• Prevent the emergence of new resistant strains of HIV.
• Suppress the virus in the blood as much as possible.

Most often two drugs from the same class are used in combination with a third drug from a different class.

Types of anti-HIV drugs include:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) inhibit proteins that HIV needs to replicate itself. Drugs in this class include efavirenz, rilpivirine (Edurant), and doravirine (Pifeltro).
• Nucleosides, or nucleoside reverse transcriptase inhibitors (NRTIs), are ineffective versions of structures that HIV needs to replicate itself. Among them, Ziagen, Viread, Emtriva, Epivir and Retrovir are drugs; however, Retrovir is not used for treatment in the U.S. because it causes toxicity.
• Combinations of drugs are also an option, such as emtricitabine-tenofovir disoproxil fumarate (Truvada) and emtricitabine-tenofovir alafenamide (Descovy).
• Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to replicate itself. These drugs include atazanavir (Reyataz), darunavir (Prezista), and lopinavir-ritonavir (Kaletra).
• Integrase inhibitors work by blocking a protein called integrase, which HIV needs to insert its genetic material into CD4 T cells. This class of drugs includes Biktarvy, raltegravir (Isentress), dolutegravir (Tivicay), and caltegravir (Vocabria).
• Entry (fusion) inhibitors block HIV from entering CD4 T cells. This class of drugs includes enfuvirtide (Fuzeon) and maraviroc (Selzentry). Newer drugs include ibalizumab (Trogarzo) and fostamxavir (Rukobia).

Prevention

There is no vaccine to prevent HIV infection, and there is no cure for HIV/AIDS. But you can protect yourself and others from infection.

Preventive Measures

To help prevent HIV transmission:

• Consider Pre-Exposure Prophylaxis (PrEP): 2 PrEP drugs taken by mouth (oral pills) and one PrEP drug given by injection (injection). There are oral medications like emtricitabine-tenofovir disoproxil fumarate (Truvada), emtricitabine-tenofovir alafenamide fumarate tablets (Descovy), and an injection called cartegravir (Apretude). It reduces the risk of HIV infection in people at high risk for sexually transmitted HIV infection. According to CDC, it may reduce the risk of sexually transmitted HIV by about 99% or reducing the risk of HIV from using injection drugs by at least 74%. Descovy has not been studied in people who have penetrating vaginal intercourse (sex with a penis inserted into their vagina). Cartegravir (Apretude) is the first FDA approved pre-exposure prophylaxis (PrEP) shot to help reduce the risk of sexually transmitted HIV infection among people at very high risk. It will be administered as an injection by your healthcare provider. A pretuade is injected by your healthcare provider every month for two months and then once every two months after that. It's another option if you would rather not take one PrEP tablet daily. Health care professionals will only prescribe these medicines to prevent HIV in people who do not already have HIV. You'll need to get an HIV test before starting any PrEP medicine. You must be tested for HIV every three months while taking oral tablets and before each dose of injections. You must take them regularly every day or take the shots on a regular schedule. Even when taking this medication, continue practicing safe sex to avoid other STIs. If you have hepatitis B, see an infectious disease or liver specialist prior to starting PrEP.
• Use a 'treatment as prevention' (TasP) strategy: If you're living with HIV, taking HIV medicine can prevent your partner from acquiring the virus; and even more importantly, a negative blood test means there is no detectable amount of the virus in your blood ('undetectable'), and you cannot transmit the virus to anyone else through sex.
• If you take TasP, it is important to follow your doctor's instructions and get regular checkups.
• If you've been exposed to HIV, use PEP to reduce the risk of getting infected by HIV. For example: while having sex; when using needles; at work. If it applies to you, speak with a health professional - call an emergency room if needed urgently! PEP is very important because it could significantly lower the risk of you getting HIV up-to-72h since the start of treatment. However, you'd be expected to stay on that for 28 days straight.
• You will also have to change a condom anew each time you have ass or vagina contact with someone. Choose between man OR woman ones. It might come handy and useful to add some lube into your routine too, but make sure to check only waterproof versions of such first!
• For oral sex, use a cut condom or medical-grade latex called a dental dam, and do not use lubricants.
• Name your sex partners if you have HIV. If I were to find out that I was HIV positive, I would name my sex partners. You got to let them know and tell them to go get tested.
• Clean needle. Use clean needles if you are shooting drugs illegally. Do not use the same needles. If there is a needle exchange program in your region, take advantage of this service. Try to ask someone for help taking their medicine.
• If you are pregnant, contact your doctor immediately; mother-child transmission is possible, and you may transmit HIV to your child through pregnancy or delivery. However, delivering the baby will not infect women who have been infected already; but mothers who take antiviral therapy during pregnancy can significantly reduce the risk of infection in infants.
• Thus, you must first tell your sex partner: Safe sex is guaranteed at 100% absolutely safe only when practicing celibacy. You should also consider factors such as consequences that might arise from the situation, and its protection against other sexually transmitted diseases, not just for protecting yourself from HIV/AIDS.
• Consider male circumcision. Studies have shown that removing the foreskin from the penis (circumcision) can help reduce the risk of HIV infection.

Related Events

Report

A woman in New York who was infected with HIV and acute myeloid leukemia (AML) became the third person in the world to be cured of AIDS after she received a stem cell transplant from a donor who is immune to HIV.

On February 15, 2022, the abstracts of the Conference on Retroviruses and Opportunistic Infections (CROI), showed that there have been three cases of curing AIDS around the world. But what happened in this case differs from the previous two ones which may bring new ideas for treating AIDS:

California's 68-year-old Paul Edmond announced five years ago, he got transplanted bone marrow, so now his acute myeloid leukemia has been almost totally cured and he could become the 5th patient around the globe who had already been cured of AIDS;

According to many famous domestic and foreign media reports, July 21st, 2024, a 60-year-old German man hasn't detected any symptom as well as alive HIV in his body since he began receiving the transplanted stem cells in 2015; until recently, he has stopped getting antiretroviral treatment for HIV in 2018! He can possibly become the 7th one around the globe who has successfully "beaten" AIDS due to the therapy of transplanting healthy hematopoietic stem cells -- almost 10 years later when being transplanted, about 6 years earlier than ending HIV treatment!

The scientists of Charité University Hospital, etc., stated during the 25th International Conference on AIDS in Munich, Germany, July 2024, they were informed by a study group led by Professor Dr. Klaus Fruehauf, a professor at Berlin Medical School in Germany: after being transplanted hematoxylin, the patient whose blood was full of virus has no detectable AIDS virus in his own organism even though several years passed after the disease-curing process was finished -- it turned out that the virus was gone without leaving any traces inside him! Such a situation is observed more often with those people infected by HIV. The same happens to the researchers' patients who managed to get their disease fully "killed" only after stopping taking antivirals against HIV and then being transplanted with healthy cells from donors. It might take up to a decade after such a procedure before it becomes apparent if an AIDS-infected man or a woman will not suffer any side effects due to the absence of drugs preventing HIV infection spread.

This makes the total number of people suffering from AIDS having already overcome this dreadful deadly disease by means of using stem cells grow up to 7.

It seems that some of us should start thinking hard why it is impossible to come up with some proper drug capable of killing off all AIDS viruses? Because this is exactly how it used to happen in ancient times -- whenever a terrible enemy attacks someone and tries its best to defeat that very somebody! Why shouldn't we think seriously over how to invent something like the SARS-CoV-2 antibody therapy -- where medicine uses a natural virus-killing defense response existing within a human body but directed towards coronavirus -- in order to fight AIDS instead of relying upon artificial ways of destroying infectious agents found inside a person's body?

On January 17, 2025, French press published news according to which, a Leukemia & Aids co-infected gentleman living in France finally "achieved success" despite being transplanted with another person's bones. That's the first ever registered instance in our country! The hospital where such a miracle took place said, formerly seven gentlemen around the globe suffered from leukaemia while being infected by a virus and succeeded in fully eliminating AIDS from their bodies thanks to transplants performed for lymphoma and/or leukemia -- six of whom shared their bone marrow with people who are carriers of the mutant gene that renders CCR5 nonfunctional.